SUBSTANCE ABUSE

PREPARED
BY
SF DIPULA

LEARNING OBJECTIVES
At the end of this lecture students should be able to:
Define terms
Identify common substances of abuse
Describe ways in which substances cause toxicity
Discuss toxic effects of substances of abuse in
when used during pregnancy
State regulations governing drugs & related
substances

WHY SUBSTANCE ABUSE?

Curiosity
To

have a good time

Friends are doing it
Improve athlete performance
Ease a problem

DEFINITION OF TERMS
Substance
o

abuse

Maladaptive pattern of use that results in clinically

significant functional impairment without satisfying the
criteria for substance dependence
The use of a substance in a manner that is detrimental to
health/ well being of the user, other individuals & the society
as a whole

Dependence
o

Individual is / feels compelled to repeatedly administer a

psychoactive substance

DEFINITION OF TERMS
Tolerance
o

The need to use an increasing amount in order to attain

the desired effects or the decreased intensity in effects
experienced with the continued use of the same amount
of the substance

Addiction
o

Extreme pattern of substance abuse in which the abuser

is continuously preoccupied with substance procurement
& use & thus neglects other responsibilities & personal
relationships

DEFINITION OF TERMS
Withdrawal

CHECK

symptoms

COMMON HOUSE HOLD

SUBSTANCES
Glue
Nail

polish remover
Methylated spirit
Lighter fluid
Spray paints
Deodorant & hair sprays
Pressurised air cleaners
ADD MORE?????

COMMON SUBSTANCES
CNS

depressants: alcohols, barbiturates,

benzodiazepines & opioids
CNS stimulants: amphetamines & their
derivatives, cocaine, caffeine & nicotine
Steroids

COMMON SINGS/SYMPTOMS OF
ABUSE
Youre

neglecting your responsibilities.

Youre using drugs under dangerous conditions
or taking risks while high
. Your drug use is getting you into legal trouble
Your drug use is causing problems in your
relationships

COMMON SIGNS/SYMPTOMS OF
ADDICTION
Development

of drug tolerance
Taking substances to prevent development of
withdrawal symptoms
Losing control over use
It dictates your life
Abandoning previously enjoyable activities
Continued use even though knowledgeable about
consequences

PHYSICAL WARNING SIGNS

Bloodshot

eyes, pupils larger or smaller than usual

Changes in appetite or sleep patterns
Sudden weight loss or weight gain
Deterioration of physical appearance, personal
grooming habits
Unusual smells on breath, body, or clothing
Tremors, slurred speech, or impaired coordination

BEHAVIOURAL SIGNS
Drop

in attendance and performance at work or

school
Unexplained need for money/financial problems;
may borrow or steal to get it.
Engaging in secretive or suspicious behaviours
Sudden change in friends, favourite hangouts,
and hobbies
Frequently getting into trouble

PSYCHOLOGICAL SIGNS
Unexplained

change in personality or attitude

Sudden mood swings, irritability, or angry outbursts
Periods of unusual hyperactivity, agitation, or
giddiness
Lack of motivation
appears lethargic
Appears fearful, anxious, or paranoid, with no
reason

DATE RAPE DRUGS

Rohypnol

roofies
Ketamine
Ecstacy

(INN flunitrazepam) also called

ROHYPNOL
Effects
Sedative
Anterograde amnesia
Muscle relaxation
Slowing of psychomotor performance

ROHYPNOL CHARACTERISTICS
Colourless
Odourless
Tasteless

KETAMINE
Anaesthetic

agent

Effects
Hallucinations
Unconsciousness
Loss of body control
Overdose may lead to death

ECSTACY
MDMA (3,4-methylenedioxy-methamphetamine)
Also

called Molly,X, Street alias

Strong stimulant
Stimulates the release of serotonin: euphoria

EFFECTS OF ECSTACY
Enhanced

sense of pleasure/ self confidence

Increased energy
Feelings of peacefulness, acceptance &
empathy
Feelings of closeness with others & desire to
touch others

CONTINUED ECSTACY USE

.Confusion
Depression
Sleep

problems
Paranoia
Anxiety
Muscle tension

Chills
Teeth clenching
Rapid eye movements
Sweating
Increased heart rate

COMMON ILICIT DRUGS

Marijuana
Cocaine
Nyaope

(cannabis)

CANNABIS
Dried

leaves of Cannabis sativa

Primary cannabinoid is 9- tetra cannabinol
(THC)
When inhaled, 20% reaches circulation
Highly lipophilic
Initially causes stimulation followed by
depressive phase

STIMULANT EFFECTS
Dream
o
o
o
o

like euphoric state characterised by:

altered sense of time

increased visual acuity
difficulty in concentrating
impaired short term memory

DEPRESSIVE EFFECTS
Drowsiness
Lethargy
Increased

appetite

REPRODUCTIVE EFFECTS
Decreases

testosterone
Low birth weights in neonates
Increased risk for foetal malformations
Decreased ovulation

NYAOPE
Syn:

Whoonga or wunga
A cocktail of dagga, heroin, ARVs, rat poison
and acid
In other instances it contains dagga, heroin,
ARVs (efavirenz), milk powder, rat poison,
bicarbonate of soda and pool cleaner

EFFECTS

Intense euphoria, deep contentment & relaxation.

The user feels warm when cold, calm when angry & filled
when hungry.
The feeling is beyond human experience & the intense
effect lasts for about 4 hrs. When this blissful state wears
off after 6 -24 hrs, agonising withdrawal symptoms set in:
severe abdominal pain & backache, sweating, chills,
anxiety, restlessness, depression, nausea &
diarrhoea.

EFFECTS
It

leads to increasing violence, stealing &

robbery among the youth.
Families live in fear of their own children.
There have been reports of gangs robbing
HIV/AIDS clinics in Soweto to obtain ARVs
Addicted users mugging ARV patients to obtain
the drugs for themselves.

COCAINE
Stimulant

effects are due to inhibition of

neuronal reuptake of NE, dopamine: increased
synaptic concentration
Drug dependence: tactile sensation ( feeling
of ants running under skin over body) causes
blisters and wounds

COCAINE
Pulmonary

effects: hyper/hypotension,
tachycardia, increased HR, rapid pulse, weak
irregular heart beat, myocardial infarction

Pulmonary

effects: chest tightness, irregular

breathing, apnea

Neuronal

toxicity: paranoia, grandiosity, delirium

PRESCRIPTION DRUGS
Anabolic steroids
Improve muscle growth
Enhance endurance
Strength

EFFECTS OF STEROIDS
Heart

attack
Stroke
Hepatotoxicity
Renal failure
Psychiatric disturbances

REPRODUCTIVE EFFECTS
Decreased

testes & sperm production

Growth of facial hair
Menstrual cycle dysfunction
females
Enlargement of clitoris
Decreased breast size

ILICIT DRUGS & THE LAW

Illegal
Not

registered (Drugs & Related Substances

Act, 1992 revised)

SUBSTANCES OF ABUSE IN
PREGNANCY
Effects classified into 3
On

the mother
On the course of pregnancy/ delivery
On the foetus, new born & developing child

ALCOHOL IN PREGNANCY
Increased

risk of spontaneous abortion

Low birth weight
Placenta abruptio
Increased perinatal mortality
Amnionitis
Increased chances of preterm deliveries
Foetal Alcohol Syndrome (FAS)

COCAINE USE IN PREGNANCY

Decreased

uterine blood flow

Spontaneous abortion
Low apgar score
Microcephaly
Delayed neurological development
Structural congenital abnormalities
Sudden Infant death Syndrome (SIDS)

NARCOTIC USE IN PREGNANCY

Higher

incidences of premature labour

SIDS
Premature

rupture of membranes
Preeclampsia
Placenta abruptio
Paediatrics born to mothers on heroin show signs of
addiction immediately after birth & congenital
abnormalities